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Volume 21, Number 9—September 2015
THEME ISSUE
Emerging Infections Program
Emerging Infections Program

Socioeconomic Disparities and Influenza Hospitalizations, Tennessee, USA

Chantel Sloan, Rameela Chandrasekhar, Edward F. Mitchel, William Schaffner, and Mary Lou LindegrenComments to Author 
Author affiliations: Brigham Young University, Provo, Utah, USA (C. Sloan); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (C. Sloan, R. Chandrasekhar, E. Mitchel, W. Schaffner, M.L. Lindegren)

Main Article

Table 2

Average annual age-standardized and race-stratified incidence of influenza hospitalizations, by neighborhood percentage of households below poverty, household crowding, and percentage of households with female head of household, Middle Tennessee, USA, October 2007–April 2014*

Characteristic Hospitalizations, no. (%) Age-standardized annual incidence (95% CI) Rate ratio Rate difference RII†
White, n = 1,242
% Below poverty
<5.0 233 (18.8) 11.0 (9.6–12.5) 2.5 (2.0–3.1)
5.0–9.9 320 (25.8) 13.6 (12.2–15.2) 1.2 (1.1–1.4) 2.7 (0.6–4.7)
10.0–19.9 374 (30.1) 16.3 (14.7–18.1) 1.5 (1.3–1.7) 5.3 (3.1–7.5)
≥20.0 315 (25.4) 23.0 (20.5–25.7) 2.1 (1.8–2.4) 12.0 (9.1–14.9)
Household crowding‡
<5.0 1,113 (89.6) 14.8 (13.9–15.7) 1.9 (1.3–2.8)
5.0–9.9 99 (8.0) 19.1 (15.5–23.2) 1.3 (1.1–1.6) 4.3 (0.4–8.1)
10.0+ 30 (2.4) 26.7 (17.9–38.9) 1.8 (1.3–2.6) 11.9 (2.2–21.6)
% Female head of household
<20.0 556 (44.8) 12.4 (11.4–13.5) 2.4 (2.0–3.0)
20.0–39.9 423 (34.1) 16.9 (15.3–18.6) 1.4 (1.2–1.5) 4.5 (2.6–6.4)
40.0–59.9 190 (15.3) 20.7 (17.8–24.0) 1.7 (1.4–1.9) 8.2 (5.1–11.4)
60.0+ 73 (5.9) 32.3 (25.1–41.3) 2.6 (2.1–3.3) 19.9 (12.2–27.5)
African American, n = 418
% Below poverty
<5.0 20 (4.8) 17.8 (10.7–28.4) 3.3 (2.2–4.8)
5.0–9.9 40 (9.6) 15.9 (11.2–22.6) 0.9 (0.5–1.6) −1.8 (−11.4 to 7.7)
10.0–19.9 79 (18.7) 21.7 (17.1–27.3) 1.2 (0.8–1.9) 4.0 (−5.4 to 13.3)
≥20.0 279 (66.7) 34.6 (30.6–39.0) 1.9 (1.5–2.5) 16.8 (7.8–25.8)
Household crowding†
<5.0 339 (81.1) 26.3 (23.5–29.3) 1.8 (1.1–2.8)
5.0–9.9 64 (14.6) 33.6 (25.2–44.4) 1.3 (1.0–1.7) 7.3 (−2.1 to 16.8)
10.0+ 15 (3.6) 41.3 (22.7–71.1) 1.6 (0.9–2.7) 15.0 (−6.6 to 36.7)
% Female head of household
<20.0 49 (11.7) 14.8 (10.9–19.9) 3.6 (2.5–5.1)
20.0–39.9 77 (18.4) 20.8 (16.1–26.8) 1.4 (1.0–1.9) 6.0 (−0.6 to 12.6)
40.0–59.9 139 (33.3) 31.6 (26.5–37.4) 2.1 (1.7–2.6) 16.7 (10.0–23.5)
60.0+ 153 (36.6) 40.0 (33.8–46.9) 2.7 (2.2–3.3) 25.1 (17.5–32.8)

*Rates within ethnic subpopulations (i.e., Hispanic) were not calculated because of low numbers for these groups. RII, relative index of inequality.
†RII is calculated as the exponent of the slope of a Poisson regression model by using incidence rate as the outcome variable and the proportion of the population in that socioeconomic group as the predictor variable. The RII can be interpreted similarly to an incidence rate ratio that compares those in the quantitatively highest category with those in the lowest categorization. For example, an RII of 2.5 would indicate a 150% increase in risk when those in the quantitatively highest category are compared with those in the lowest (such as the <49.9% category being compared with the 66.0–74.9 category for percentage of patients employed). A low RII with CIs <1 would indicate decreased risk.
‡Household was evaluated for number of persons per room.

Main Article

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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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